Metastatic papillary thyroid carcinoma typically appears in local lymph nodes, nasal and skull base metastases are rare. The authors describe the third case of Metastatic papillary thyroid carcinoma to nasal cavities and paranasal cavities in the literature.The objective of this study is to describe - from our clinical case and from literature review- the clinical radiological features of this rare entity, and to discuss its therapeutic management. Until now, there is not enough data on postoperative radioactive iodine ablation, external radiation, or chemotherapy, but early diagnosis is essential for an ideal care. It seems that surgical approach is one of the best methods to manage and eradicate this type of tumor.

1. Case Report
An Unusual Cause of Nasal Mass: Metastatic
Papillary Thyroid Carcinoma to Nasal Cavities
and Paranasal Cavities -
Omar Iziki*, Kaoutar Chaker, Ahmed B Ahmedou, Sami Rouadi,
Redallah Abada, Mohamed Roubal and Mohamed Mahtar
Department of Otorhinolaryngology, Head and Neck Surgery, King Hassan II University & Ibn Rochd
Hospital of Casablanca, Morocco
*Address for Correspondence: Omar Iziki, Department of Otorhinolaryngology, Head and Neck
Surgery, King Hassan II University, Ibn Rochd Hospital, Casablanca, Morocco, Tel: +212-061-395-3181;
E-mail:
Submitted: 31 May 2019; Approved: 04 June 2019; Published: 05 June 2019
Cite this article: Iziki O, Chaker K, Ahmedou AB, Rouadi S, Abada R, et al. An Unusual Cause of
Nasal Mass: Metastatic Papillary Thyroid Carcinoma to Nasal Cavities and Paranasal Cavities. Int J
Rhinol Otological. 2019;2(1): 005-007.
Copyright: © 2019 Iziki O, et al. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.
International Journal of Rhinology &
Otolaryngology

2. SCIRES Literature - Volume 2 Issue 1 - www.scireslit.com Page -006
International Journal of Rhinology & Otolaryngology
INTRODUCTION
Papillary Thyroid Cancer (PTC), the most common thyroid
malignancy, is associated with an excellent prognosis. It is a well-
differentiated malignant tumor, which accounts for 1% of all
malignant tumors. Metastatic thyroid carcinoma usually appears in
the local lymph nodes. Indeed, distant metastases of papillary thyroid
carcinoma are uncommon and the most common site of metastasis is
lung followed by bone. PTC metastatic to nasal and paranasal region
is extremely rare and only 2 cases have been reported in the English
scientific literature until April 2019 [1,2]. In this article authors
describe the third case of distant metastasis of a PTC to nasal cavities
and paranasal sinuses.
CASE REPORT
A 69-year-old female, without important pathological
antecedents, referred to our center in the ENT department of Head
and Neck Surgery at the King Hassan II University of Casablanca by
an ophthalmologist with one-sided progressive exophthalmos, nasal
obstruction and epistaxis, for more than seven months.
Physical examination, revealed a large goiter, neglected over than
14 years according to the patient, with a discrete left exophthalmos,
and reduction of visual acuity in the same side (Figure 1).
Nasal examination showed a dark pink mass occupying the
totality of the left nasal cavity.
Computed Tomography (CT) of the Paranasal Sinuses (PNS)
revealed a polypoid soft-tissue mass located in the left nasal cavity,
left maxillary and sphenoidal sinuses, with an invasion orbital apex,
the optic canal and the skull base (Figure2).
A biopsy of nasal mass was performed under local anesthesia
followed by a massive bleeding managed by a nasal packs.
Histopathological examination revealed papillary cell carcinoma
(Figure 3).
Patient underwent a total thyroidectomy. Followed by
scintigraphy, showig fixation on nasal, paranasal cavities and skull
base, with no other metastasis. Final decision was to perform a
palliative radiation therapy.
DISCUSSION
Papillary Thyroid Carcinoma (PTC) derives from the thyroid
follicular epithelial cells. It’s the most common malignant thyroid
neoplasm in countries with sufficient iodine diets and comprises
up to 80% of all thyroid malignancies [3]. This malignant tumor
remains latent and does not or very slowly grow and associated with
a low mortality rate. While lymph node metastases are often present
at diagnosis (average about 50%, can be as high as 85-90% in some
ABSTRACT
Metastatic papillary thyroid carcinoma typically appears in local lymph nodes, nasal and skull base metastases are rare. The authors
describe the third case of Metastatic papillary thyroid carcinoma to nasal cavities and paranasal cavities in the literature. The objective
of this study is to describe - from our clinical case and from literature review- the clinical radiological features of this rare entity, and to
discuss its therapeutic management. Until now, there is not enough data on postoperative radioactive iodine ablation, external radiation,
or chemotherapy, but early diagnosis is essential for an ideal care. It seems that surgical approach is one of the best methods to manage
and eradicate this type of tumor.
Keywords: Papillary thyroid carcinoma; Nasal cavities; Paranasal cavities; Metastase
Figure 1: Photograph shows a large goiter, with a left exophthalmos.
Figure 2: CT scan show the PTC of the nasal and paranasal cavities with
invasion of orbit optic canal and skull base.
Figure 3: Papillary thyroid carcinoma configuration on histologic examination.

3. SCIRES Literature - Volume 2 Issue 1 - www.scireslit.com Page -007
International Journal of Rhinology & Otolaryngology
series), haematogenous spread is rather a rare and late event [4]. In
contrast, distant metastases are very frequently found in children
and adolescents [5]. The most common sites of distant metastases
reported in literature are bone and lungs and less commonly brain,
liver, bladder, and skin. Bone metastases can occur in the vertebral
bodies followed by the pelvis, femur and skull. They are the principal
cause of death in well-differentiated thyroid carcinoma cases is
distant metastasis [6].
Metastases of thyroid carcinoma to PNS are fairly uncommon, few
cases have been reported, dominated by undifferentiated or follicular
thyroid carcinoma [7]. To our best knowledge, only 2 cases of PTC
metastatic to nasal and paranasal cavities have been documented in
the literature untel 2018 [1,2].
Madan et al. in 2013 presented the first case, a 45-year-old
male with a large mass in the left side of nasal cavity that caused
the destruction of the nasal septum and sphenoid wing, erosion of
sphenoid and ethmoid sinus, involvement of cavernous sinus and
expansion of medial wall of both orbits. The patient underwent
radiation therapy. According to their reports, no significant changes
were demonstrated in comparison to baseline imaging and patients
had stable disease [2].
The second case of PTC metastatic to nasal and paranasal cavities
has been published in 2018 by Pourseirafi et al. [1]. They reported a
55-year-old female with one-sided nasal obstruction and rhinorrhea
in her nose, She was a known case of papillary thyroid carcinoma with
metastases to the pelvic and lung. Patient’s PNS CT with contrast
revealed an irregular border mild enhancing tumoral solid mass
measuring 30×30 mm at the anterior inferior of the right nasal cavity
without calcification or lytic osseous lesion at adjacent bone and PNS
were clear [1]. The mass was removed by Functional endoscopic sinus
surgery.
There’s no treatment algorithm or clear consensus for
management of PTC in the skull base and paranasal cavities. Based
on a case series of five solitary follicular thyroid carcinomas of the
skull base, Rosahl et al. [4] proposed a simple treatment algorithm.
The authors suggested that 131-I whole body scan and thyroidectomy
are indicated if a diagnosis of skull base metastasis of differentiated
thyroid cancer is made [5]. If 131-I uptake is detected, postoperative
radioiodine ablation therapy should be freely implemented.
Conversely, in the absence of 131-I uptake, external beam radiation
therapy was stressed [3].
In our case, we performed a total thyroidectomy given the
volume of goiter. Surgery was not possible; tumor was large and had a
massive invasion of the skull base. Our patient underwent a palliative
radiation therapy.
CONCLUSION
To the best of our knowledge, we have presented the third report
of PTC in the nasal cavity. There is not enough data on postoperative
radioactive iodine ablation, external radiation, or chemotherapy, but
early diagnosis is essential for an ideal care. It seems that surgical
approach is one of the best methods to manage and eradicate this
type of tumor.
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